Transcript The Reliability and Validity of a Spanish Translation of

Parent-Child Interaction
Therapy (PCIT) with Puerto
Rican families
Maribel Matos-Román, Ph.D.
University of Puerto Rico
PCIT Conference
January 26-28, 2006
Gainesville, FL
Specific Aims

To revise and culturally adapt PCIT for Puerto
Rican preschool aged children with a
diagnosis of ADHD who also present high rates
of behavior problems.

To conduct a randomized controlled pilot
study to evaluate the initial efficacy,
feasibility, and acceptability of the refined
PCIT for children with a diagnosis of ADHD and
problem behaviors and their families.
Inclusion criteria
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4 to 6 years – 11 months of age
Parent complaints of significant hyperactivity
and behavior problems
No evidence of neurological, pervasive
developmental disorders or significant
handicaps
Be a child of a Puerto Rican mother
No treatment with stimulant or psychotropic
medication
No involvement in other forms of child
psychotherapy and/or pharmacotherapy
Inclusion criteria
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IQ > 80 (PPVT)
ADHD diagnosis, Combined or HyperactiveImpulsive Type - NIMH DISC-IV.
A score above the 93rd percentile on
hyperactivity and ODD or aggression scales
(DBRS or BASC)
Absence of domestic violence and chaotic
family environment
No indicators of severe psychopathology on
parents
Aim 1

Translation of the PCIT manual and handouts

Linguistic adaptations

Psychoeducational module about ADHD and
behavior problems
– Description of hyperactivity and its relationship
to behavior problems
– Associated difficulties
– Risks and protective factors
– Possible etiologies
– Treatment options
Aim 1

Nine families
– 9 children

7 M and 2 F; Mean age: 4.9 years; Mean IQ:
104.4, SD = 10.08
– 9 mothers
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2 single parents, Mean age: 31.89, SD = 6.31
Range: 25 to 43
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Education: 15.6 years (nearly a BA, SD = 1.59;
Range: 14 to 19)

7 worked full-time, 1 part-time, 1 college student
Aim 1

Nine families
– 7 fathers (1 stepfather)

Mean age: 32.86, SD = 5.34 Range: 27 to 43

Education: 16.0 years (BA, SD = 3.79; Range: 12
to 23

Full-time jobs
Aim 1

Procedures
– Screening and outcome measures (Pre-
treatment assessment)
– Psychoeducational sessions (2 sessions)
– CDI and PDI

Mean CDI sessions = 7.47 (6 - 9)
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Mean PDI sessions= 7.79 (6 - 10)
– Post treatment assessment
– 3-month follow-up assessment
Screening Measures

Disruptive Behavior Scale for Children (DBRS)
– 9 hyperactivity symptoms, 8 ODD symptoms
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Behavioral Assessment System for ChildrenParent Rating Scales (BASC-PRS)
– Subscales of Hyperactivity and Aggression
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Peabody Picture Vocabulary Test (PPVT-HAA)
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NIMH DISC IV - Parent Version
– ADHD, ODD, generalized anxiety disorder,
separation anxiety disorder, major depression, and
disthymia modules
Outcome Measures
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Eyberg Child Behavior Inventory (ECBI)
Child Behavior Checklist (CBCL)
BASC, DBRS
Home Situations Questionnaire (HSQ)
Family Experiences Inventory (FEI)
Parent Practices Inventory (PPI)
Beck Depression Inventory (BDI)
Symptom Checklist – 36 (SCL-36)
Treatment and Evaluation Survey (TES)
Therapy Attitude Inventory (TAI)
Results
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PCIT feasible to implement and acceptable
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High level of satisfaction
– Mean TAI score: 48.67, SD=1.32
– Mothers’ reports of being felt understood,
confident, comfortable, and supported by their
therapists.
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Positive changes in children’s behavior
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Reduction in family stress
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Improvement in parent-child relationships
Results
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Treatment gains maintained through 3-month
follow-up
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Reliable change index (RCI)
– 89% in ECBI-Intensity and the ECBI-Problem
– 62% in ADHD-Hyperactivity
– 88% in ODD
– 56% in the PPI
– 78% in the FEI
Modifications
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8 sessions for CDI and 9 for PDI
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Handout about pharmacological
treatment for ADHD
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Modification of time-out procedures
– Loss of privileges
– Definition of silence
– Duration of time-out
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Scripts for CDI and PDI
Aim 2 – Pilot Study
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32 families
– Treatment group (TG); n=20
– Wait-list group (WL); n= 12
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No difference between groups
– gender distribution
– age
– IQ
– parents’ education
– children’s impairment in adaptive functioning
– screening ratings of hyperactivity and
aggressive or ODD behaviors
Sample Demographic and Clinical Characteristics
Treatment Group
W-list group
χ2 /t
Participants
20
12
----
Gender (% male)
70
67
.04
Age (months)
58.50 (6.37)
60.00 (7.47)
-.61
Peabody (IQ)
101.95 (13.96)
106.67 (7.81)
-1.23
Mother’s education
15.40 (1.82)
14.58 (1.31)
1.36
Mother’s age
33.05 (7.48)
32.08 (6.29)
.38
BASC-Hyperactivity
35.95 (6.94)
36.00 (6.49)
-.02
BASC-Aggression
18.10 (5.74)
21.25 (5.50)
-1.53
DBRS-Hyperactivity
21.25 (3.82)
22.67 (2.84)
-1.11
DBRS-No. Hyp. Symptoms
7.60 (1.60)
8.08 (1.16)
-.91
DBRS-ODD
16.05 (3.89)
17.92 (3.87)
-1.32
DBRS – No. ODD symptoms
5.85 (1.53)
6.33 (1.23)
-.93
C-GAS
53.30 (6.44)
56.83 (4.97)
-1.63
Measure
Results – Pilot Study
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Treatment Group (n=19)
– Lower levels of hyperactivity
– Less aggressive and ODD behaviors
– Less externalizing behaviors
– Significant reduction in general
behavioral problems (ECBI)
– Significant reduction in the behaviors
they assessed as problematic (ECBIProblems)
Results – Pilot Study
– Reduction in the parenting stress (FEI)
– Use of adequate parenting practices
– Mean CDI sessions: 7 (6 to 9)
– Mean PDI sessions: 8 (6 to 10)
– High level of consumer satisfaction
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Mean TAI scores: 47.77 (SD: 2.93)
Wait-list Group (n= 12)
– No significant changes in any measure

ANCOVAs with pretreatment scores as
covariates.
ECBI Intensity & Problems
80
T scores
70
Intensity
Problems
60
50
40
30
TG
WLG
Pre
Post
TG
Follow Up
WLG
BASC Hyperactivity & Aggression
40
Hyperactivity
35
Raw scores
30
25
Aggression
20
15
10
5
0
TG
WLG
Pre
Post
TG
Follow Up
WLG
DBRS Hyperactivity & ODD
30
Raw scores
25
Hyperactivity
20
ODD
15
10
5
0
TG
WLG
Pre
Post
TG
Follow Up
WLG
CBCL Externalizing & Aggressive
80
Externalizing
Aggressive
T scores
70
60
50
40
30
TG
WLG
Pre
Post
TG
Follow Up
WLG
Home Situations - Total & Severity
16
Total
Raw scores
12
8
Severity
4
0
TG
WLG
Pre
Post
TG
Follow Up
WLG
Parenting Practices
Raw scores
120
105
90
75
60
45
30
15
0
TG
WLG
Pre
Post
Follow Up
Raw scores
Family Stress
100
90
80
70
60
50
40
30
20
10
0
TG
Pre
WLG
Post
Follow Up
BDI & SCL - 36
70
SCL - 36
Raw scores
60
50
40
30
20
BDI
10
0
TG
WLG
Pre
Post
TG
Follow Up
WLG
Conclusions
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PCIT seems to be:
–
A responsive family intervention for
Puerto Rican families who have
preschool- age children with significant
behavior problems.
–
An acceptable and effective treatment
for Puerto Rican parents.
–
Efficacious to reduce significantly the
behavior problems associated with
ADHD and ODD.
Research Team
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Co-investigators
– José J. Bauermeister, Ph.D.
– Guillermo Bernal, Ph.D.
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Data Analysis
– José V. Martínez, Ph.D.
– Eduardo Cumba, Ph.D.
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Research Assistants
Graduate students
•Rosalie Torres
•Rocheli Santiago
•Ixa Rodriguez
•Liliana Torres
•Michelle Jurado
•Elisabet Avilés
•Kenneth Junco
Undergraduate students
•Marisol De Jesús
•Damaris Cordero
•Wilmarie Ríos
•Arlene Román
Acknowledgments
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Funded by NIMH 5R24MH-49368-11
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Dr. Maribel Matos
E-mail: [email protected]
¡Gracias!